HIV Co-Morbidities and Multi-Morbidities

Abstract

Several challenges confront those patients living and growing older with HIV disease with regard to non-communicable diseases, including cancer, addictive behaviors, fracture prevalence, heart disease and affective disorders, that present physical and mental health problems among the HIV positive [1-5]. Indeed, frailty and a conglomeration of behavioral risk factors are associated with multisystem co-morbid vulnerability that predict survival and multi-morbidity incidence among patients [6,7]. In a cohort of Romanian HIV patients, Streinu-Cercel et al. [8] observed moderately high prevalence of chronic renal disorders accompanied by moderately low occurrence of osteopenia and osteoporosis in comparison with these patents from other European countries with smoking addict an important risk factor renal and cardiac conditions, as well as impaired bone metabolism [9], for further bone health co-morbidities). Bolduc et al. [10] have listed several medical complications and multi-morbidities accompanied by multiple infection risk, including Pneumocystis jirocii, pneumonia, candida esophagitis, toxoplasmic encephalitis, tuberculosis, crytococcal meningitis, disseminate Mycobacterium avium complex, and cytomegalovirus retinitis, as well as 'wasting' syndrome and HIVencephalitis. According to the definitive study performed by Kilbourne et al. [11] among the most commonly observed HIV comorbidities presented by patients are to be included: oral candidiasis (21%), peripheral neuropathy (16%), and herpes zoster (16%) whereas those general medical comorbidities involved chemical hepatitis (53%), hypertension (24%), and hyperlipidemia (17%) with neuropsychiatric comorbidities offering a greater burden of disease among HIV-infected patients indicating that 32% of patients presented anxiety, 4% mania, 4% schizophrenia, and 11% cognitive impairment/dementia although estimations seem bedeviled by variations in symptom expression [12]. The seriousness of these latter cognitive deficits appears to constitute an especially heavy burden for everyday functioning and quality-oflife parameters [13,14]. The etiopathogenesis of the neuropsychiatric comorbidities, most particularly depressiveness and mood disorders, among HIV-infected patients affects deleteriously and markedly the quality-of-life, medication compliance, and disease prognosis in those afflicted; not least of all, the prevailing relationships between HIVrelated stigma, HIV-disclosure, social support networks, and mood and depression among patients await description and expression [15]. The situation is rendered even more serious in view of the inadequacy of certain regional public health medical services especially among minorities and vulnerable groups that require more effective health practices and long-term policies [16].

Epidemiology of multimorbidity among people living with HIV in sub-Saharan Africa: a systematic review protocol

“… 10 The implication of these emerging non-AIDS conditions is a devastating increase in the burden of multimorbidity ranging from chronic non-communicable diseases (NCD) such as obesity/overweight and cardiometabolic conditions, chronic cardiovascular diseases, dysfunctional immune systems to concomitant disruptions of cognitive function and mental health conditions. 11 12 The huge overlap between killer infections such as HIV, tuberculosis (TB), with NCDs like hypertension and diabetes mellitus (DM) results in a ‘double burden of disease’ in loe-income and middle-income countries. 13 This double burden of disease as explained by Bates et al 13 can also be referred to as multimorbidity (as defined below), and this causes a huge health problem in PLHIV in sub-Saharan Africa.…”

“…Currently, there is paucity of evidence using literature-based synthesis to evaluate the occurrence of multimorbidity in PLHIV from sub-Saharan Africa. The studies providing evidence on HIV morbidities from settings in sub-Saharan Africa, 26–28 are majorly observational studies and fewer compared with the larger literature from high-income countries, 11 29–35 however, most sampling an ageing population. Given the detrimental effects of emerging multimorbidity within the context of long-term survival with HIV, there is a need to synthesise available evidence to determine the trends and magnitude of multimorbidity among PLHIV.…”